Patient characteristics and inequalities in doctors’ diagnostic and management strategies relating to CHD: A video-simulation experiment

Arber, Sara; McKinlay, John B.; Adams, Ann; Marceau, Lisa D.; Link, Carol L.; O’Donnell, Amy B.

doi:10.1016/j.socscimed.2005.05.028

Cited by 153 publications

(155 citation statements)

References 29 publications

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“…The construction of gender is done in interaction, involving the patient as well as the doctor or other caregivers. There are several examples from research where identical narratives are interpreted in different ways depending on whether the future science group future science group www.futuremedicine.com narrator was male or female [7,19,20,52]. Translated to clinical situations this means that when male and female patients tell their stories, the doctor, nurse or other member of the healthcare staff is inclined to interpret even identical narratives in different ways because of assumptions and preconceived ideas about women and men.…”

Section: Adding Gender Theorymentioning

confidence: 99%

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Gender Bias in Medicine

Hamberg

2008

Womens Health (Lond Engl)

250

146

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Gender bias has implications in the treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender blindness and stereotyped preconceptions about men and women are identified as key causes to gender bias. However, exaggeration of observed sex and gender differences can also lead to bias. This article will examine the phenomenon of gender bias in medicine, present useful concepts and models for the understanding of bias, and outline areas of interest for further research. Research has shown that different biological processes, anatomies, conditions in daily life, environmental experiences, risk behaviors and responses to stressful events, may all contribute to variation in health and disease in men and women [1-5]. There is also evidence that women, for no apparent medical reason, are not offered the same treatment as men, a phenomenon that raises the question of gender bias. Many studies, for example, show that women are less likely than men to receive more advanced diagnostic and therapeutic interventions [6-11]. The word bias means 'prejudice' or 'distortion' and is a threatening phenomenon in all kinds of research and human activity. When we talk about gender bias in medicine we usually either mean an unintended, but systematic neglect of either women or men, stereotyped preconceptions about the health, behavior, experiences, needs, wishes and so on, of men and women, or neglect of gender issues relevant to the topic of interest. Gender bias has implications in treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender bias is also a relevant issue in the discussion of clinical and academic advancements and careers [12]; however, that aspect is not the focus of this article. Since there is confusion in medicine about the use of the concept of gender [13], my use of the term is presented below.

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Section: Adding Gender Theorymentioning

confidence: 99%

“…There is also evidence that women, for no apparent medical reason, are not offered the same treatment as men, a phenomenon that raises the question of gender bias. Many studies, for example, show that women are less likely than men to receive more advanced diagnostic and therapeutic interventions [6][7][8][9][10][11].…”

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confidence: 99%

Gender Bias in Medicine

Hamberg

2008

Womens Health (Lond Engl)

250

146

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“…Furthermore, studies comparing the vignette methodology with other methods, such as standardized patients and chart abstraction, have shown that vignettes provide valid estimates for studies of medical decision making. [32][33][34][35][36] Although a simple explanation for our finding of gender ageism may be that physicians are merely combining information from the case presentation with their previous knowledge of CHD risk profiles (i.e., being good Bayesians) to properly ascribe a lower likelihood of CHD to younger women, 9,21 this theory alone is unconvincing for two main reasons. First, the most recent epidemiological data show that the gender difference in CHD rates is consistent throughout the adult age span.…”

Section: Maserejian Et Almentioning

confidence: 99%

“…1,2 In particular, research indicates that the care a patient receives may be as much a function of who the patient is (age, gender, race= ethnicity, socioeconomic status [SES]), who the provider is (age, gender, specialty), and where the care is delivered (private= public facility, geographic location) as it is of the symptoms actually present. [3][4][5][6][7][8][9][10] A compelling example is coronary heart disease (CHD), the single greatest cause of death for men and women in the United States and Europe. Remarkably, women generally have lower age-adjusted CHD incidence and mortality than men.…”

mentioning

confidence: 99%

Disparities in Physicians' Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment

Maserejian

Link

Lutfey

et al. 2009

Journal of Women's Health

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Background: Previous studies have documented the underdiagnosis of coronary heart disease (CHD) in women, but less is known about which alternate diagnoses take precedence and whether additional patient factors modify possible gender bias. Objective: To measure gender variation in clinical decision making, including (1) the number, types, and certainty levels of diagnoses considered and (2) how diagnoses vary according to patient characteristics, when patients have identical symptoms of CHD. Methods: This was a factorial experiment presenting videotaped CHD symptoms, systematically altering patient gender, age, socioeconomic status (SES) and race, and physician gender and level of experience. The primary end point was physicians' most certain diagnosis. Results: Physicians (n ¼ 128) mentioned five diagnoses on average, most commonly heart, gastrointestinal, and mental health conditions. Physicians were significantly less certain of the underlying cause of symptoms among female patients regardless of age ( p ¼ 0.006), but only among middle-aged women were they significantly less certain of the CHD diagnosis ( p < 0.001). Among middle-aged women, 31.3% received a mental health condition as the most certain diagnosis, compared with 15.6% of their male counterparts ( p ¼ 0.03). An interaction effect showed that females with high SES were most likely to receive a mental health diagnosis as the most certain ( p ¼ 0.006). Conclusions: Middle-aged female patients were diagnosed with the least confidence, whether for CHD or non-CHD conditions, indicating that their gender and age combination misled physicians, particularly toward mental health alternative diagnoses. Physicians should be aware of the potential for psychological symptoms to erroneously take a central role in the diagnosis of younger women.

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“…12 A rich international literature highlights that a patient's inclination to participate in medical decision making, notably on cardiovascular disease management, varies by characteristics, such as age and education, but also by sex, coping style, and severity of condition. [13][14][15][16][17][18] This emphasises the health disparities, notably concerning the management of cardiovascular risk factors in the context of primary care. The agreement between patients and their GPs was better for tangible aspects of the consultation, such as measurements and physical examinations undertaken (auscultation, measuring blood pressure and weight) and information given, compared to more abstract dimensions, such as counselling and assessing patients' physical activity and alcohol intake.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Do doctors and patients agree on cardiovascular-risk management recommendations post-consultation? The INTERMEDE study

Schieber

Kelly-Irving²,

Rolland³

et al. 2011

Br J Gen Pract

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Understanding interactions between patients and GPs is potentially important for optimising communication during consultations and improving health promotion, notably in the management of cardiovascular risk factors. [1][2][3] Little is known of the role played by these interactions in the maintenance or production of health disparities. 4-6The objective of this study was to explore the concordance between GPs and patients' declarations on the management of cardiovascular risk factors, and to explore whether potential disagreement was linked to patients' educational level. METHOD Study designThe design and methods of the INTERMEDE study's quantitative phase (Figure 1) AimTo explore the agreement between physicians and patients on the management of cardiovascular risk factors, and whether potential disagreement is linked to the patient's educational level. Design of studyINTERMEDE is a cross-sectional study with data collection occurring at GPs' offices over a 2-week period in October 2007 in France. MethodData were collected from both patients and doctors respectively via pre-and post-consultation questionnaires that were 'mirrored', meaning that GPs and patients were presented with the same questions. ResultsThe sample consisted of 585 eligible patients (61% females) and 27 GPs. Agreement between patients and GPs was better for tangible aspects of the consultation, such as measuring blood pressure (κ = 0.84, standard deviation [SD] = 0.04), compared to abstract elements, like advising the patient on nutrition (κ = 0.36, SD = 0.04), and on exercise (κ = 0.56, SD = 0.04). Patients' age was closely related to level of education: half of those without any qualification were older than 65 years. The statistical association between education and agreement between physicians and patients disappeared after adjustment for age, but a trend remained. ConclusionThis study reveals misunderstandings between patients and GPs on the content of the consultation, especially for health-promotion outcomes. Taking patients' social characteristics into account, notably age and educational level, could improve mutual understanding between patients and GPs, and therefore, the quality of care.

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Patient characteristics and inequalities in doctors’ diagnostic and management strategies relating to CHD: A video-simulation experiment

Cited by 153 publications

References 29 publications

Gender Bias in Medicine

Gender Bias in Medicine

Disparities in Physicians' Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment

Do doctors and patients agree on cardiovascular-risk management recommendations post-consultation? The INTERMEDE study

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